Provider Demographics
NPI:1104848175
Name:SOMMERS, LINETTE HOLBROOK (LCSW)
Entity Type:Individual
Prefix:
First Name:LINETTE
Middle Name:HOLBROOK
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:57 DORA LN
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1187
Practice Address - Country:US
Practice Address - Phone:606-473-7333
Practice Address - Fax:606-473-7335
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000485982OtherANTHEM BCBS
11623633OtherCAQH
KY30610026Medicaid
0519320Medicare PIN